Journal of Yeungnam Medical Science

Case report

Gastroenterology and Hepatology
Primary hepatic sarcoidosis presenting with cholestatic liver disease and mimicking primary biliary cholangitis: a case report: Young Joo Park, Hyun Young Woo, Moon Bum Kim, Jihyun Ahn, Jeong Heo; J Yeungnam Med Sci. 2022;39(3):256-261. Published online August 10, 2021; DOI: https://doi.org/10.12701/yujm.2021.01151

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Sarcoidosis often involves the liver. However, primary hepatic sarcoidosis confined to the liver without evidence of systemic involvement is rare. We report the case of a 37-year-old man with hepatic sarcoidosis who initially presented with elevated liver enzymes and suspicious cirrhotic nodules on computed tomography. The patient had cirrhosis but did not have portal hypertension. Based on the initial histopathologic finding of chronic granulomatous inflammation and the common clinical characteristics of sarcoidosis, he was initially diagnosed with primary biliary cholangitis, and his daily dosage of ursodeoxycholic acid was increased to 900 mg. After 14 months of treatment, his total serum bilirubin concentration was 10.9 mg/dL (upper normal limit, 1.2 mg/dL). Additionally, a transjugular liver biopsy revealed multiple noncaseating granulomas. He was diagnosed with primary hepatic sarcoidosis involving the lungs, heart, spleen, kidneys, and skin. Treatment with methylprednisolone was initiated. Two weeks later, he was started on azathioprine, and the dose of steroid was simultaneously reduced. These findings indicate the importance of including hepatic sarcoidosis as a possible diagnosis in patients with elevated liver enzymes or cryptogenic cirrhosis.

Citations

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Hepatic Sarcoidosis Mimicking a Metastatic Tumor: A Case Report
Naohiro Nakamura, Yoshiki Mastsuno, Kazunori Aoi, Hisashi Kosaka, Sanshiro Kobayashi, Yu Takahashi, Tomomitsu Tahara, Yuri Noda, Koji Tsuta, Makoto Naganuma
Internal Medicine.2025;[Epub] CrossRef
Liver biopsy as a useful diagnostic tool for hepatic sarcoidosis: A case report
Kenrei Uehara, Tatsuo Kanda, Shuhei Arima, Mai Totsuka, Masayuki Honda, Ryota Masuzaki, Reina Sasaki‑tanaka, Naoki Matsumoto, Masahiro Ogawa, Hirofumi Kogure
Medicine International.2024;[Epub] CrossRef
Navigating Challenges in a Case of Unusual Hepatic and Pulmonar Sarcoidosis: A Comprehensive Clinical Journey
André Gonçalves, Diogo Simas, Plácido Gomes, Carina Leal, Catarina Atalaia-Martins, Helena Vasconcelos
GE - Portuguese Journal of Gastroenterology.2024; : 1. CrossRef
The clinical management of hepatic sarcoidosis: A systematic review
Ram Prasad Sinnanaidu, Vikneshwaran Chandra Kumar, Ranita Hisham Shunmugam, Sanjiv Mahadeva
JGH Open.2024;[Epub] CrossRef
Gastrointestinal Manifestations of Sarcoidosis: A State-of-the-Art, Comprehensive Review of the Literature—Practical Clinical Insights and Many Unmet Needs on Diagnosis and Treatment
Salvatore Nicolosi, Maria Chernovsky, Darina Angoni, Michael Hughes, Giulia Bandini, Zsuzsanna McMahan, Marta Maggisano, Francesco Salton, Lucrezia Mondini, Mariangela Barbieri, Gianluca Screm, Marco Confalonieri, Elisa Baratella, Paola Confalonieri, Barb
Pharmaceuticals.2024; 17(9): 1106. CrossRef
An Incidental Case of Sarcoidosis in a Young Male Patient Presenting With Symptomatic Chronic Cholecystitis
Kelsey A Clabby, Yelena Piazza, Vladimir Neychev
Cureus.2024;[Epub] CrossRef

Case Reports

Gastroenterology and Hepatology
Simultaneous chylothorax and chylous ascites: Tae Soo Jang, In Beom Jeong, Do Yeun Cho, Sung Ju Kang, Oh Jung Kwon; Yeungnam Univ J Med. 2017;34(2):265-269. Published online December 31, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.2.265

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Abstract PDF: Chylothorax or chylous ascites are rare manifestations of liver cirrhosis. We report a rare case of simultaneous chylothorax and chylous ascites in a patient with hepatitis B virus-related liver cirrhosis. A 76-year-old woman was referred to our hospital with a pleural effusion on her right side. She had no history of recent medical procedures, trauma or tumor. There was no evidence of mass or thoracic duct obstruction in a computed tomography scan. Pleural fluid and ascites were confirmed as chylothorax and chylous ascites by chemistry analysis. Despite thorough conservative care, there was no improvement. Pleurodesis was planned, but hepatic encephalopathy developed suddenly and she did not recover.

Gastroenterology and Hepatology
Budd-Chiari syndrome with antiphospholipid syndrome and systemic lupus erythematosus in a patient with Klinefelter's syndrome: Mingee Lee, Jin Young Huh, Ji Hyang Lee, Sun myoung Kang, Jae Yong Lee, Oh Chan Kwon, Eun Na Kim, Jihun Kim, Danbi Lee; Yeungnam Univ J Med. 2017;34(2):260-264. Published online December 31, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.2.260

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Abstract PDF: Klinefelter's syndrome is the most common congenital abnormality that causes primary hypogonadism. It is associated with diseases that predominantly affect women, such as systemic lupus erythematosus (SLE), and it can sometimes cause veno-occlusive disease. We experienced a case of Budd-Chiari syndrome (BCS) in a 33-year-old man with Klinefelter's syndrome presented with hematemesis and edema in both lower extremities. The clinical and laboratory findings were compatible with SLE, antiphospholipid syndrome, and BCS. To the best of our knowledge, this is the first case report to describe a simultaneous presentation of these four clinical syndromes in a single patient.

Gastroenterology and Hepatology
Massive bleeding from a rectal Dieulafoy lesion in a patient with alcoholic cirrhosis: Young Hoon Choi, Jong Ryeol Eun, Jae Ho Han, Hyun Lim, Jung A Shin, Gun Hwa Lee, Seung Hee Lee; Yeungnam Univ J Med. 2017;34(1):88-90. Published online June 30, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.1.88

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Abstract PDF: Although Dieulafoy lesion can occur in any part of the gastrointestinal tract, its occurrence in the rectum is rare. Rectal Dieulafoy lesions have been associated with advanced age, renal failure, burns, liver transplantation and cirrhosis. Here, we report on a case of massive bleeding from a rectal Dieulafoy lesion after lung decortication surgery in a 57-year-old male patient with alcoholic cirrhosis. Although rare, a rectal Dieulafoy lesion should be included in the differential diagnosis of massive lower gastrointestinal bleeding in a patient with cirrhosis.

A Case of Colchicine-Induced Neutropenia in Liver Cirrhosis Patient.: Ho Chan Lee, Heon Ju Lee, Yong Gil Kim, Jae Hyun Park, Sung Joon Kim, Jun Seok Park; Yeungnam Univ J Med. 2009;26(2):125-129. Published online December 31, 2009; DOI: https://doi.org/10.12701/yujm.2009.26.2.125

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Abstract PDF: Colchicine is an alkaloid that has been used for treating acute gouty arthritis, psoriasis, scleroderma and Behcet's syndrome. Colchicine decreased liver fibrosis in rats with carbon tetrachloride induced cirrhosis and in patients with many liver diseases. Therapeutic oral doses of colchicine may cause nausea, vomiting, abdominal pain and diarrhea. The adverse effect of colchicine associated with the dose is bone marrow suppression, and especially neutopenia. Neutropenia has often been reported in patients have taken an overdose of colchicine. We describe a 64-year-old female liver cirrhosis patient with neutropenia that was induced by a therapeutic dose of colchicine.

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